6.5 & 7.3mm Cann Screws PDF

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Part of the DePuy Synthes Cannulated Screw System

6.5 mm and 7.3 mm Cannulated Screws Surgical Technique

Table of Contents

Introduction

Surgical Technique

Product Information

6.5 mm and 7.3 mm Cannulated Screws

2

AO Principles

3

Indications

4

Surgical Technique Information

5

Percutaneous Technique

6

Open Technique

10

Implant Removal

12

Implants

13

Instruments

14

Set Lists

18

MR Information The 6.5 mm and 7.3 mm Cannulated Screw System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the 6.5 mm and 7.3 mm Cannulated Screw System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

1

6.5 mm and 7.3 mm Cannulated Screws

Features – Cannulated shaft accepts 2.8 mm diameter guide wires (threaded and nonthreaded wires available) – Hemispherical head ensures optimal annular contact with DePuy Synthes washers and plates when screws are angled – Low-profile head helps reduce possibility of soft tissue irritation – Reverse-cutting flutes assist in screw removal – Choice of thread lengths offers best fit of threads into far bone fragment, for greater interfragmentary compression – Cancellous thread profile uses deep cutting threads with a large pitch to increase resistance to pullout. The large pitch also accelerates screw insertion and removal – Self-drilling, self-tapping screw tip facilitates screw insertion by eliminating the need for predrilling and tapping in most cases

Self-drilling, self-tapping flutes Cancellous thread design

Deeper threads for maximum pullout resistance

Reverse-cutting flutes

4.8 mm diameter shaft

Hemispherical, low profile head with 4.0 mm hex drive Rigid 2.8 mm guide wire, made of high strength L-605 alloy 6.5 mm

7.3 mm

Materials Implant quality 316L stainless steel

Thread lengths 16 mm thread 32 mm thread

Titanium alloy (Ti-6AI-7Nb)

Fully threaded

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DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

AO Principles

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1, 2

Anatomic reduction Fracture reduction and fixation to restore anatomical relationships.

Early, active mobilization Early and safe mobilization and rehabilitation of the injured part and the patient as a whole.

1

2

4

3

Stable fixation Fracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supply Preservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991. 2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart New York: Thieme; 2007.

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Indications

6.5 mm and 7.3 mm Cannulated Screws are intended for fracture fixation of large bones and large bone fragments. 6.5 mm Cannulated Screws are also indicated for: – Femoral neck fractures – Slipped capital femoral epiphyses – As an adjunct to DHS in basilar neck fractures – Tibial plateau fractures – Ankle arthrodeses – Pediatric femoral neck fractures – Intercondylar femur fractures – Sacroiliac joint disruptions – Subtalar arthrodeses

Femoral neck fractures

Slipped capital femoral epiphyses

As an adjunct to DHS in basilar neck fractures

Tibial plateau fractures

Warning: This device is not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine.

Miss-A-Nail

4

DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

Surgical Technique Information

Cleaning cannulations Instruments 310.63

5.0 mm Cannulated Drill Bit

311.689

Cannulated Tap

319.24

2.9 mm Cleaning Brush

319.46

2.8 mm Cleaning Stylet

Note: Cleaning the cannulation in each instrument is imperative for proper function. Instruments should be cleared intraoperatively with the 2.8 mm cleaning stylet to prevent accumulation of debris in the cannulation and potential binding of the instruments about the guide wire. Postoperatively, they should be cleaned with both the cleaning stylet and cleaning brush. Drilling and tapping The self-drilling, self-tapping flutes of the 6.5 mm and 7.3 mm cannulated screws make predrilling and tapping unnecessary in most cases, but in very dense bone, it may be helpful to use the 5.0 mm cannulated drill bit and the cannulated tap. Considerations for selecting the 6.5 mm versus the 7.3 mm cannulated screw Dimensionally, the thread and head diameters of the 6.5 mm cannulated screw are smaller than those of the 7.3 mm cannulated screw. The core and shaft diameters are the same. With regard to screw performance, the deep cutting threads on the 7.3 mm cannulated screw give it greater pullout resistance (about 10%), whereas the 6.5 mm screw is optimized for use in a smaller bone space, with multiple adjacent screws, and through plates. Bending strength, insertion torque and torsional strength are essentially equivalent.

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Percutaneous Technique

1 Insert guide wire Instruments 292.68

2.8 mm Threaded Guide Wire

312.01

2.8 mm Adjustable Parallel Wire Guide

312.02

2.8 mm Trocar

312.05

12.0 mm/8.5 mm Protection Sleeve

312.08

8.5 mm/ 2.8 mm Wire Sleeve

312.692

Multiple Wire Guide

Insert the percutaneous sleeve assembly through a stab incision and through the soft tissue to the bone. Remove the trocar. Under power, insert the 2.8 mm threaded guide wire through the inner sleeve into the bone. Check for appropriate depth under image intensifi cation. Note: When using the cannulated instrument shafts over the extra long 450 mm guide wire, a cannulated coupling device or Jacobs chuck is required.

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DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

Percutaneous Technique continued

Option 1a: Insert additional parallel guide wire(s) with adjustable parallel wire guide Use the 2.8 mm adjustable parallel wire guide to place parallel wires at various distances from the fi rst wire. Place the fixed sleeve over the previously inserted wire and adjust the movable sleeve to the desired position and distance. Tighten the knurled nut on the adjustable sleeve to lock it in place. Insert the desired number of additional wires. Note: The placement of three guide wires is recommended to achieve adequate rotational stability. Option 1b: Insert multiple parallel guide wire(s) using multiple wire guide Insert the multiple wire guide and trocar through a stab incision and through the soft tissue to the bone. Remove the trocar. Select hole pattern and insert 2.8 mm guide wires through the preselected holes. Once all wires are placed, use the protection sleeve to protect the soft tissue while measuring and inserting screws. Note: The multiple wire guide will allow placement of washers when wires are placed through nonadjacent holes. Placement through adjacent holes will allow clearance for screws but not for washers.

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Percutaneous Technique continued

2 Countersink (optional) Instrument 310.78

Cannulated Countersink

When a lower screw profile is necessary, use the cannulated countersink to create a recess for the screw head. Note: If the countersink fails to bite, the near cortex can be predrilled using the cannulated drill bit.

3 Measure for screw length Instrument 319.70

Cannulated Screw Measuring Device

Remove wire sleeves or guides and slide the tapered end of the cannulated screw measuring device over the guide wire and through the protection sleeve to the bone. Read the scale at the end of 300 mm wires, or at the 300 mm calibration marking on 450 mm wires, to determine insertion depth of wire and appropriate screw length. Notes: – The reading indicates the screw length that will place the screw at the tip of the guide wire. Subtract appropriately for any anticipated inter fragmentary compression resulting from screw insertion. – Only use the guide wire in its original length to ensure correct measurement. – If planning to countersink, this should be done prior to inserting the cannulated screw measuring device.

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DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

Percutaneous Technique continued

4 Insert screw Instruments 310.495

7.3 mm Cannulated Drill Bit

310.63

5.0 mm Cannulated Drill Bit

314.05

Cannulated Hexagonal Screwdriver

314.11

Holding Sleeve

314.23

Cannulated Hexagonal Screwdriver Shaft

314.05

Using the cannulated hexagonal screwdriver, place the appropriate length screw over the guide wire through the protection sleeve, and insert into the bone. Remove and discard the guide wire. For power insertion of screws, use the cannulated hexagonal screwdriver shaft and holding sleeve. Always use the cannulated hexagonal screwdriver for final, manual seating of the screw. Use of a washer should be considered when using the 7.3 mm drill bit to make a gliding hole, or inserting the screw into osteoporotic bone. Note: In very dense bone, it may be helpful to predrill the cortex with the 5.0 mm drill bit.

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Open Technique

1 Set angle of variable angle wire guide Instrument 312.07

Variable Angle Wire Guide

Prior to inserting guide wires, place the variable angle wire guide directly on the bone and select the insertion angle.

2 Insert guide wires and measure Select a hole pattern and insert the 2.8 mm guide wires through the preselected holes. Once all wires are placed, use the protection sleeve to protect the soft tissue while measuring for screw length. Note: The variable angle wire guide will allow placement of washers when wires are placed through nonadjacent holes. Placement through adjacent holes will allow clearance for screws but not for washers.

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DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

Open Technique continued

3 Insert screws Instrument 314.05

Cannulated Hexagonal Screwdriver

Using the cannulated hexagonal screwdriver, place the appropriate length screw over the guide wire and through the protection sleeve, and insert into the bone. Remove and discard the guide wire.

314.05

For power insertion of screws, use the cannulated hexagonal screwdriver shaft and holding sleeve. Always use the cannulated hexagonal screwdriver for final, manual seating of the screw. Use of a washer should be considered when using the 7.3 mm drill bit to make a gliding hole, or inserting the screw into osteoporotic bone. Note: In very dense bone, it may be helpful to predrill the cortex with the 5.0 mm drill bit.

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Implant Removal

Instruments 313.93

Solid Hexagonal Screwdriver, 4.0 mm width across flats

314.04

Solid Hexagonal Screwdriver Shaft, 4.0 mm width across flats

393.10

Universal Chuck with T-Handle

Expose the screw head and remove the screws using the special screwdriver for the removal of cannulated screws. Precaution: Do not use the cannulated screwdriver for implant removal.

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DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

Implants in the 6.5 mm and 7.3 mm Cannulated Screw System Stainless steel and titanium

6.5 mm Cannulated Screws, 16 mm thread length – 30 mm– 150 mm lengths in 5 mm increments – 160 mm– 180 mm lengths in 10 mm increments – 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

6.5 mm Cannulated Screws, 32 mm thread length – 45 mm– 150 mm lengths in 5 mm increments – 160 mm– 180 mm lengths in 10 mm increments – 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

6.5 mm Cannulated Screws, fully threaded – 20 mm– 130 mm lengths in 5 mm increments – 140 mm– 180 mm lengths in 10 mm increments – 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

7.3 mm Cannulated Screws, 16 mm thread length – 30 mm– 150 mm lengths in 5 mm increments – 160 mm– 180 mm lengths in 10 mm increments – 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

7.3 mm Cannulated Screws, 32 mm thread length – 45 mm– 150 mm lengths in 5 mm increments – 160 mm– 180 mm lengths in 10 mm increments – 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

7.3 mm Cannulated Screws, fully threaded – 20 mm– 130 mm lengths in 5 mm increments – 140 mm– 180 mm lengths in 10 mm increments – 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

Washer, 13.0 mm – To prevent screw head from sinking into osteoporotic bone – 316L stainless steel or commercially pure (CP) titanium

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Instruments

292.68

2.8 mm Threaded Guide Wire, 300 mm

310.495

7.3 mm Cannulated Drill Bit, large quick coupling

310.63

5.0 mm Cannulated Drill Bit, large quick coupling

310.78

Cannulated Countersink

311.689

Cannulated Tap

312.01

2.8 mm Adjustable Parallel Wire Guide

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DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

Instruments continued

312.02

2.8 mm Trocar

312.05

12.0 mm/ 8.5 mm Protection Sleeve

312.07

Variable Angle Wire Guide

312.08

8.5 mm/2.8 mm Wire Sleeve

312.09

15.5 mm/ 13.0 mm Washer Sleeve

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Instruments continued

312.692

Multiple Wire Guide

312.694

2.8 mm Trocar, for Multiple Wire Guide

313.93

Solid Hexagonal Screwdriver, 4.0 mm width across flats

314.04

Solid Hexagonal Screwdriver Shaft, 4.0 mm width across flats

314.05

Cannulated Hexagonal Screwdriver, 2.9 mm cannulation, 4.0 mm width across flats

314.11

Holding Sleeve

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DePuy Synthes

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique

Instruments continued

314.23

Cannulated Hexagonal Screwdriver Shaft

319.24

2.9 mm Cleaning Brush

319.46

2.8 mm Cleaning Stylet

319.70

Cannulated Screw Measuring Device

319.97

Screw Forceps

338.49

Large Quick Coupling

6.5 mm and 7.3 mm Cannulated Screws

Surgical Technique DePuy Synthes

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Cannulated Screw Instrument and Implant Sets

Sets 105.180

105.185

105.190

145.180

145.185

145.190

6.5 mm Cannulated Screw Instrument and Implant Set (consists of Graphic Case 690.379, Screw Racks 690.375.60 and 690.375.70, and Screw Sets 105.181 and 105.182) 7.3 mm Cannulated Screw Instrument and Implant Set (consists of Graphic Case 690.380, Screw Racks 690.375.40 and 690.375.50, and Screw Sets 105.186 and 105.187) 6.5 mm and 7.3 mm Combined Cannulated Screw Instrument and Implant Set (consists of Graphic Case 690.375, Screw Racks 690.375.50 and 690.375.70, and Screw Sets 105.181 and 105.186) 6.5 mm Titanium Cannulated Screw Instrument and Implant Set (consists of Graphic Case 690.379, Screw Racks 690.375.60 and 690.375.70, and Titanium Screw Sets 145.181 and 145.182) 7.3 mm Titanium Cannulated Screw Instrument and Implant Set (consists of Graphic Case 690.380, Screw Racks 690.375.40 and 690.375.50, and Titanium Screw Sets 145.186 and 145.187) 6.5 mm and 7.3 mm Titanium Combined Cannulated Screw Instrument and Implant Set (consists of Graphic Case 690.375, Screw Racks 690.375.50 and 690.375.70, and Titanium Screw Sets 145.181 and 145.186)

Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to www.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.

The 6.5 mm and 7.3 mm cannulated screws are available in six different instrument and implant sets, three with stainless steel screws and three with titanium. Each set includes the same set of instruments, but a different combination of two screw sets. Set Name

6.5 mm Partially Threaded Screws

6.5 mm Fully Threaded Screws

x

x

6.5 mm Cannulated Screw Instruments and Implant Set 7.3 mm Cannulated Screw Instruments and Implant Set 6.5 mm and 7.3 mm Combined Cannulated Screw Instruments and Implant Set

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DePuy Synthes

x

6.5 mm and 7.3 mm Cannulated Screws

7.3 mm Partially Threaded Screws

7.3 mm Fully Threaded Screws

x

x

x

Surgical Technique

Cannulated Screw Instrument and Implant Sets continued

Instruments (included in all the instrument and implant sets listed on page 18) 292.68 2.8 mm Threaded Guide Wire, 300 mm, 10 ea. 310.495 7.3 mm Cannulated Drill Bit, large quick coupling, 300 mm, 2.9 mm cannulation 310.63 5.0 mm Cannulated Drill Bit, large quick coupling, 300 mm, 2.9 mm cannulation 310.78 Cannulated Countersink, for 6.5 mm and 7.3 mm Cannulated Screws 311.689 Cannulated Tap for 6.5 mm and 7.3 mm Cannulated Screws, 275 mm/ 200 mm tap depth 312.01 2.8 mm Adjustable Parallel Wire Guide 312.02 2.8 mm Trocar, for use with 5.0 mm/ 2.8 mm Wire Sleeve (312.03) 312.05 12.0 mm/8.5 mm Protection Sleeve 312.07 Variable Angle Wire Guide 312.08 8.5 mm/2.8 mm Wire Sleeve 312.09 15.5 mm/13.0 mm Washer Sleeve 312.692 Multiple Wire Guide, for use wit...